Discussion This analysis of more than patients with a first venous thromboembolism who were followed, on average, for 2. The epidemiology of venous thromboembolism in the community: Physician knowledge, attitudes, and beliefs are therefore partially responsible for the gap between actual practice and international guidelines [ 7 ]. In individual studies assessing patients with treated venous thromboembolism, the risk of recurrent disease was higher in men than in women in most, 5 6 56 57 58 59 60 61 62 but not all, 8 63 studies. The results indicate that the observed bleeding rates associated with new use of dabigatran do not appear to be higher than the bleeding rates associated with new use of warfarin [ 32 ].
N Engl J Med ; However, a sex specific predilection to risk factors for venous thromboembolism, apart from use of hormonal therapy and pregnancy, seems unlikely. Prospective clinical trials are needed to support these clinical observations. Studies specifically conducted on geriatric older, frail population with multiple co-morbidities are therefore needed to evaluate tolerance of NOACs in real life conditions. Also, mortality often occurred during the first year after diagnosis, which was much earlier than the mortality events in the control cohort. Venous thromboembolism and bleeding in a community setting: Whereas in cancer-associated VTE and second unprovoked VTE lifelong anticoagulation is universally accepted, a careful analysis of the benefit vs. Firstly, our findings are limited to the studies included in this meta-analysis. Thus, the efficacy of VKA administration decreases over time since the index event [ 23 ]. Not surprisingly, in view of its actual and perceived bleeding risks, warfarin continues to be largely underused in clinical practice [ 11 ]. It was therefore concluded that treatment with VKA strongly reduces the risk of recurrent VTE for as long as they are used. Sensitivity analyses Interaction between age, sex, and hormone associated initial venous thromboembolism—The interaction between age and sex suggested that age was a predictor in women only hazard ratio 1. Again, bleeding data for the NOACs are derived from the carefully selected patients enrolled in clinical trials. Recurrence is also often associated with a high fatality rate in certain geographic areas. Statistical Analysis The categorical variables, such as age groups, sexes, and comorbidities, are presented at frequency with percentage. Discussion This analysis of more than patients with a first venous thromboembolism who were followed, on average, for 2. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: The CFR from major bleeding remains constant throughout therapy. The drugs that have completed phase 3 trials for VTE include: Another report pointed that VTE unrelated to a transient risk factor was associated with increased mortality compared to mortality in patients with a transient risk factor hazard ratio HR 2. In another study assessing risk of recurrence after hormone associated initial venous thromboembolism, although the risk of recurrence did not seem to be lower in women with oral contraceptive associated venous thromboembolism hazard ratio 0. The bleeding risk profile of the NOACs seemed initially to be more favorable while maintaining a non-inferiority efficacy versus warfarin. The IRs for recurrences was particularly high in young men [ 19 ]. Table 3 Cumulative incidence of recurrent venous thromboembolism VTE in all patients according to sex and hormonal therapy status View this table: Anticoagulant therapy is accordingly a double-edged sword; evaluating patients is therefore complex as it requires balancing the risks of recurrent VTE in the absence of anticoagulation against the risks of bleeding complications with continued pharmacological therapy [ 5 ]. JD and AI are the guarantors. Therefore, advancing age is not a predictor of recurrent VTE but is associated with more PEs yet with a significant increase in major bleeding episodes with VKA use [ 25 ].
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